TEMPS-A: progress towards validation of a self-rated clinical version of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire

BACKGROUND: Our aim was to validate the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) in a clinical population. METHODS: The study was conducted in two Memphis mood clinics involving 398 affectively ill patients with young to middle index age (42 years+/-13 S.D.), who were 95% white, 62% female, and 51% bipolar spectrum. A subset of 157 of the entire sample were retested in 6-12 months, and the entire sample was then subjected to factor analysis (PCA extraction method with varimax rotation). RESULTS: We obtained high test-retest reliability ranging from 0.58 for the irritable, to 0.68, 0.69 and 0.70, respectively, for the cyclothymic, dysthymic and hyperthymic. The hypothesized four-factor structure of the TEMPS-A was upheld, with the cyclothymic explaining 14% of the variance, followed by the irritable, hyperthymic, and dysthymic together accounting for another 14%. Internal consistency was excellent, with Chronbach alphas ranging from 0.76 for the dysthymic to 0.88 for the cyclothymic. Exploratory factor analysis revealed 2 super factors, Factor I loading on cyclothymic, irritable, and dysthymic temperaments, and Factor II loading heavily on the hyperthymic. The 50-item TEMPS-A-Clinical Version was constructed by using a cutoff of alpha > or =0.4 for traits loading exclusively on their original temperaments. We also proposed a longer 69-item version for future study, in which we permitted a greater number of traits based on clinical considerations (alpha cutoff 0.30). LIMITATION: The sample was preponderantly white, and may not generalize to other U.S. ethnic groups. This earlier version of TEMPS-A did not include the anxious temperament. CONCLUSIONS: We psychometrically validated the TEMPS-A in affectively ill outpatients, leading to an instrument suitable for use in psychiatric, especially affectively ill, populations. It is noteworthy that in this clinically ill population we succeeded in measuring traits which could make subjects vulnerable to affective episodes, as well as those of adaptive nature. For instance, the dysthymic emerged as bound to routine, self-blaming, shy-nonassertive, sensitive to criticism, yet self-denying, dependable, and preferring to work for someone else rather than be the boss. The hyperthymic had the highest number of "positive" traits: upbeat, fun-loving, outgoing, jocular, optimistic, confident, full of ideas, eloquent, on the go, short-sleeper, tireless, who likes to be the boss, but single-minded, risk-taker, and unlikely to admit to his/her meddlesome nature. The cyclothymic emerged as labile with rapid shifts in mood; unstable in energy, self-esteem and socialization; unevenly gifted and dilettante; yet keen in perception, intense in emotions, and romantic. The irritable emerged as skeptical and critical (which might be considered intellectual virtues), but otherwise having the "darkest" nature of all temperaments: grouchy, complaining, dissatisfied; anger- and violence-prone, and sexually jealous. The foregoing temperament attributes, observed in a moderately severe group of patients with affective disorders, nonetheless testify to the evolutionary context of these disorders-"submissive" behavior, territoriality, romantic charm, and last, but not least, sexually jealous with its associated specter of violence. We hypothesize that the putative social and limbic mechanisms underlying mood disorders appear to have archaic origins on an evolutionary scale. We finally submit that the traits underlying affective disorders are very much part of human nature.     

Development of a brief screening instrument: the HANDS

BACKGROUND: The present study was designed to develop a briefer screening scale of approximately 10 items which maintained the validity of the Zung Self-Rating Depression Scale in a sample similar to that attending National Depression Screening Day (NDSD), as well as a more general audience. METHODS: We first administered 70 items from a variety of existing rating scales to 40 subjects who answered an ad for depressed subjects and 55 who answered an ad for non-depressed subjects, all of whose diagnoses were confirmed by the Structured Clinical Interview for DSM-IV (SCID). Based on the correlation between each item and the diagnostic criterion, we reduced the number of items to 17 which we then administered to another 45 subjects who answered an ad similar to that used for NDSD and also underwent a SCID interview. Based on these results, we arrived at the final 10-item Harvard Department of Psychiatry/NDSD scale (HANDS) with the assistance of the item-response theory. The items are scored for frequency of occurrence of each symptom over the past 2 weeks. Total scores range from 0 to 30. RESULTS: The 10-item scale (HANDS) has good internal consistency and validity: a cutpoint score of 9 or greater gave sensitivity of at least 95% in both studies. Although specificity was lower for all scales in the self-selected population, the HANDS performed at least as well as the 20-item Zung Scale, the 21-item Beck Depression Inventory-II and the 15-item Hopkins Symptom Depression Checklist. CONCLUSION: The 10-item HANDS performs as well as other widely used longer self-report scales and has the advantage of briefer administration time.     

Development and validation of the immunosuppressant therapy adherence instrument (ITAS)

A five-item scale was developed that asked respondents to indicate how often they were non-adherent to immunosuppressant therapy (IST) given a particular circumstance. Two hundred and twenty-two recipients completed the instrument. Validity of the scale was assessed by correlating composite item scores with refill record adherence rates (RRARs), serum immunosuppressant (IS) concentrations, graft rejection, and increased serum creatinine (SCr) levels. One scale item was deleted due to lack of response variability. Cronbach's alpha coefficient for the four-item scale was 0.81, demonstrating that the scale has acceptable reliability. All items loaded on a single principal component, suggesting that the scale measures a single adherence construct, which accounted for 64% of the scale items' variance. The four-item scale, adherence measured by IS RRARs, and "target" IS serum concentrations had positive correlations (p < 0.01). Item scores were shown to be negatively related to rejection occurrence and increased SCr (p < 0.05). The immunosuppressant therapy adherence scale is the first published, valid and reliable instrument that measures recipients IST adherence.     

TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament

OBJECTIVE: To validate a short English-language version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), a self-report questionnaire designed to measure temperamental variations in psychiatric patients and healthy volunteers. Its constituent subscales and items were formulated on the basis of the diagnostic criteria for affective temperaments (cyclothymic, dysthymic, irritable, hyperthymic, and anxious), originally developed by the first author and his former collaborators. Further item wording and selection were achieved at a later stage through an iterative process that incorporated feedback from clinicians, researchers, and research volunteers. METHOD: A total of 510 volunteers (284 patients with mood disorders, 131 relatives of bipolar probands, and 95 normal controls) were recruited by advertisement in the newspapers, announcements on radio and television, flyers and newsletters, and word of mouth. All participants were interviewed using the Structured Clinical Interview for DSM-III-R, and completed the 110-item TEMPS-A and the Temperament and Character Inventory (TCI-125). The factorial structure, the alpha coefficients, and the item-total correlations coefficients of the TEMPS-A and the correlation coefficients between the dimensions of the TCI and the TEMPS-A subscales were then determined. RESULTS: A principal components analysis with a Varimax rotation found that 39 out of the 110 original items of the TEMPS-A loaded on five factors that were interpreted as representing the cyclothymic, depressive, irritable, hyperthymic, and anxious factors. Coefficients alpha for internal consistency were 0.91 (cyclothymic), 0.81 (depressive), 0.77 (irritable), 0.76 (hyperthymic), and 0.67 (anxious) subscales. We found statistically significant positive correlations between all-but the hyperthymic-subscales and harm avoidance. Positive correlations with the hyperthymic and cyclothymic, and novelty seeking and negative correlations with the remaining subscales were also recorded. Other major findings included positive correlations between the hyperthymic and reward dependence, persistence and self-directedness; positive correlation between the self-transcendence and the cyclothymic, hyperthymic and the anxious; and negative correlations between the depressive, cyclothymic, irritable, anxious and cooperativeness. LIMITATION: As the full-scale anxious temperament was added after the four scales of the TEMPS-A were developed, it has only been evaluated in 345 subjects. CONCLUSIONS: These data indicate that the TEMPS-A in its shortened version is a psychometrically valid scale with good internal consistency. The proposed five subscale structure is upheld. Concurrent validity against the TCI is shown. Most importantly, for each of the temperaments, we were able to show positive attributes which are meaningful in an evolutionary context, along with traits which make a person vulnerable to mood shifts. This hypothesized dual nature of temperament, which is upheld by our data, is a desirable characteristic for a putative behavioral endophenotype in an oligogenic model of inheritance for bipolar disorder.     

The Maternal Disintegrative Responses Scale (MDRS): Development and initial validation

Objective

This study aimed to design and examine the validity of the Maternal Disintegrative Responses Scale (MDRS) to assess intrusive thoughts and dissociative experiences in the postpartum period.

Method

A convenience sample of 455 mothers whose babies were up to 12 months old completed the MDRS and a series of questionnaires assessing postnatal depression (Edinburgh Postnatal Depression Scale [EPDS]), childbirth-related post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and general symptoms of dissociation.

Results

The final scale consists of eight items tapping two dimensions, intrusive thoughts and dissociative experiences, and displays good psychometric properties. Both factors were found to be related to EPDS, PTSD OCD, and general symptoms of dissociation. Primiparous women scored higher than multiparous women on both dimensions, and mothers of infants up to 3 months old scored higher on dissociative experiences than those whose infants were aged 4–12 months.

Conclusions

The MDRS can contribute to the theoretical and practical conceptualization and assessment of these phenomena.     

Measuring depression in women around menopausal age: towards a validation of the Edinburgh Depression Scale

BACKGROUND: The relationship between menopause and depression is still rather unclear. Studies using different methodology - especially those lacking a clear definition of depression - are hardly comparable. Since the Edinburgh Depression Scale (EDS) is not influenced by (menopause-related) somatic symptoms, the validity of the Dutch version of this instrument was investigated in a large community sample of menopausal women. METHODS: In 951 women, aged between 47 and 56 years, depressive symptomatology was measured using the EDS, together with a syndromal diagnosis of depression using Research Diagnostic Criteria. RESULTS: Twenty-two percent of the subjects had scores of 12 or higher on the EDS. With this cut-off point, depression (major or minor) was detected with a sensitivity of 66%, a specificity of 89%, and a positive predictive value (PPV) of 62%. A cut-off score of 15 or higher detected half of the women with major depression (sensitivity 73%, specificity 93%, PPV 53%). LIMITATIONS: Screening of depressive symptomatology at menopausal age in women of the community can only partly detect women with clinical depression. The relation between menopausal status and depression should preferentially be investigated using a longitudinal rather than a cross-sectional design. CONCLUSIONS: The EDS, which is easy to implement in both community and clinical settings (e.g., General Practice), might be used as an effective screening tool for detecting women at menopausal age who are at risk for depression, followed by clinical evaluation in those with high scores.     

Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16)

STUDY OBJECTIVE: Sleep related cognitions (e.g., faulty beliefs and appraisals, unrealistic expectations, perceptual and attention bias) play an important role in perpetuating insomnia. This paper presents new psychometric data on an abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), a 16-item self-report measure designed to evaluate a subset of those sleep related cognitions. DESIGN: Psychometric study of a patient-reported measure of sleep related beliefs based on existing clinical and research databases. PARTICIPANTS: A total of 283 individuals (60% women; mean age of 46.6 years old) with insomnia, including 124 clinical patients and 159 research participants. MEASUREMENTS AND RESULTS: Participants completed the DBAS, Insomnia Severity Index, Beck Depression and Anxiety Inventories, daily sleep diaries for 2 weeks, and 3 nights of polysomnography (research sample only) as part of a baseline assessment. The DBAS-16 was found to be reliable, as evidenced by adequate internal consistency (Cronbach alpha = 0.77 for clinical and 0.79 for research samples) and temporal stability (r = 0.83). The factor structure was similar to the original 30-item version, with 4 factors emerging and reflecting: (a) perceived consequences of insomnia, (b) worry/helplessness about insomnia, (c) sleep expectations, and (d) medication. DBAS total scores were significantly correlated with other self-report measures of insomnia severity, anxiety, and depression, but not with specific sleep parameters. CONCLUSION: The psychometric qualities of this abbreviated DBAS-16 version seem adequate. This patient-reported measure should prove a useful instrument to evaluate the role of sleep related beliefs and attitudes in insomnia and to monitor change on this cognitive variable as a potential moderator of treatment outcome.     

Patient requests in primary health care settings: Development and validation of a research instrument

The development of the Primary Care Patient Request Scale and factor analytic and validation data from four diverse clinic samples are reported. The factor analysis yielded five plausible request dimensions: Treatment of Psychosocial Problems, Medical Explanation, Supportive Communication, Test Results, and Ventilation and Legitimation. The construct validity of the instrument was tentatively supported by the ability of the factor scales to discriminate consistently among the nature of the presenting complaint, the type of primary care clinic, and the marital status of the patient. Establishment of the clinical and research utility of the Primary Care Patient Request Scale awaits further efforts at cross-validation.     

青少年生活方式问卷的初步编制及信效度检验

目的:编制青少年生活方式问卷(Chinese Adolescent Lifestyles Scale,CALS)并检验其信效度。方法:采用分层整群取样的方法对全国9个省(自治区、直辖市)的15000名初一至大四在校学生进行问卷调查,回收有效问卷10899份。通过项目分析筛选题目,对数据进行探索性因素分析和验证性因素分析检验问卷的结构效度,用自尊量表(the Self-esteem Scale,SES)和流调中心用抑郁量表(Center for Epide-miologic Studies Depression Scale,CES-D)来检验效标效度,并检验问卷的信度。结果:(1)青少年生活方式问卷共49个题目,分为两个部分,第一部分包含8个因子,分别为饮食习惯、睡眠状况、卫生习惯、学习习惯、体育锻炼、娱乐活动、人际关系、应对方式,第二部分包含1个因子生活满意度。(2)问卷第一部分探索性因素分析所得的题目负荷在0.50～0.82之间,累计方差贡献率为55.15%。总体样本以及分年级样本验证性因素分析所得指标均符合心理测量学的要求(RMSEA0.08,NFI0.9,NNFI0.9,CFI0.9)。问卷第一部分与第二部分的Cronbach a系数分别为0.91和0.83,第一部分8个因子的Cronbach a系数在0.68～0.84之间。问卷各因子与第一部分总分之间的相关系数在0.51～0.78之间,各因子之间的相关系数在0.19～0.59之间(均P0.01)。(3)问卷两个部分与SES的相关系数分别为0.47和0.45(均P0.01),与CES-D的相关系数分别为-0.37和-0.43(均P0.01)。结论:青少年生活方式问卷具有较好的信效度,可用于测量青少年的生活方式。     

Development and validation of the Psychological Adaptation Scale (PAS): Use in six studies of adaptation to a health condition or risk

Objective

We introduce The Psychological Adaptation Scale (PAS) for assessing adaptation to a chronic condition or risk and present validity data from six studies of genetic conditions.

Methods

Informed by theory, we identified four domains of adaptation: effective coping, self-esteem, social integration, and spiritual/existential meaning. Items were selected from the PROMIS “positive illness impact” item bank and adapted from the Rosenberg self-esteem scale to create a 20-item scale. Each domain included five items, with four sub-scale scores. Data from studies of six populations: adults affected with or at risk for genetic conditions (N = 3) and caregivers of children with genetic conditions (N = 3) were analyzed using confirmatory factor analyses (CFA).

Results

CFA suggested that all but five posited items converge on the domains as designed. Invariance of the PAS amongst the studies further suggested it is a valid and reliable tool to facilitate comparisons of adaptation across conditions.

Conclusion

Use of the PAS will standardize assessments of adaptation and foster understanding of the relationships among related health outcomes, such as quality of life and psychological well-being.

Practice implications

Clinical interventions can be designed based on PAS data to enhance dimensions of psychological adaptation to a chronic health condition or risk.     

The Utian Quality of Life (UQOL) Scale: development and validation of an instrument to quantify quality of life through and beyond menopause

OBJECTIVE: Quality of life (QOL) is an outcome variable requiring measurement in clinical care or pivotal regulatory trial research. Current menopause QOL measures are mostly life phase or disease symptom inventories or scores. Believing that QOL should refer more to "sense of well-being," we have developed the Utian QOL scale (UQOL) that is strongly based on perception of sense of well-being as distinct from menopausal symptoms. DESIGN: A pool of items sampling various aspects of well-being was developed. Peri- and postmenopausal women (n = 327) responded to the items, and their responses were subjected to a factor analysis. Four factors emerged, each representing a QOL domain. The resulting 23-item instrument was validated in a geographically and socioeconomically diverse sample of peri- and postmenopausal women using the Short Form-36, an established, frequently used QOL inventory. QOL domains were subjected to confirmatory factor analyses, formal item analysis was completed, and the measure was assessed for reliability and validity, including a second sample of women (n = 270). RESULTS: Women (n = 597; mean age, 52.9 years) from 12 communities across the United States completed the measure. The UQOL seems to reflect four components of QOL: occupational QOL, health QOL, emotional QOL, and sexual QOL. The questionnaire and scoring system are presented. CONCLUSION: We are reporting on the process of validating an instrument for quantifying sense of well-being in a perimenopausal population. Substantial reliability and validity estimates for the scale and its subscales support the UQOL as a valuable new tool for use in clinical research and practice.     

巴甫洛夫气质问卷中文版(PTS-C)的编制

目的:编制适合我国成人使用的巴甫洛夫气质问卷中文版(PTS-C).方法:对我国14岁以上不同性别、职业、文化程度的363名被试施测巴甫洛夫气质问卷通用条目,依据标准的条目筛选程序对条目进行筛选,得到PTS-C.然后对初三、高三和大三年级学生280名施测PTS-C和EPQ,对成人组被试64名两次施测PTS-C,间隔时间两周.结果:PTS-C问卷包括兴奋强度、抑制强度和灵活性三个分量表,每个分量表各24题,共72题.PTS-C问卷的一致性信度(Cronbach α系数:0.74～0.85)和再测信度(r:0.84～0.88)较高,PTS-C与EPQ分量表的相关水平符合理论预期,验证性因素分析表明问卷具有良好的结构效度.结论:PTS-C可以用于我国成人气质研究.     

Concurrent validation of the Levels of Attribution and Change (LAC) Scale

This study examined the temporal reliability and concurrent validity of the LAC Scale, a multidimensional measure of the loci of causal attributions, in a sample of 95 college students. Test-retest coefficients for the 10 subscales averaged .78 for a 2-week interval and .70 for 4 weeks. Six of seven hypotheses related to concurrent validity were supported empirically, including predicted interrelations between the LAC and social desirability, distress severity, psychological-mindedness scores, and the expanded Attributional Style Questionnaire. It is concluded that the LAC Scale is an internally and temporally reliable instrument that possesses concurrent validity and that measures attributional dimensions largely independent of the ASQ.     

The Couples' Illness Communication Scale (CICS): Development and evaluation of a brief measure assessing illness‐related couple communication

Objectives. When one member of a couple has a chronic illness, communication about the illness is important for both patient and partner well‐being. This study aimed to develop and test a brief self‐report measure of illness‐related couple communication. Design. A combination of correlations and multiple regression were used to assess the internal consistency and validity of the Couples' Illness Communication Scale (CICS). Methods. A scale to provide insight into both patient and partner illness communication was developed. The CICS was then tested on patients with ovarian cancer (N =123) and their partners (N =101), as well as patients with early stage multiple sclerosis (MS) who had stable partnerships (N =64). Results. The CICS demonstrated good acceptability, internal consistency, convergent validity (correlations with general couple communication and marital adjustment), construct validity (correlations with intrusive thoughts, social/family well‐being, emotional impact of the illness, and psychological distress), and test–retest reliability. Conclusions. The CICS meets the majority of psychometric criteria for assessment measures in both a life‐threatening illness (ovarian cancer) and a chronic progressive disease (MS). Further research is required to understand its suitability for use in other populations. Adoption of the CICS into couple‐related research will improve understanding of the role of illness‐related communication in adjustment to illness. Use of this short, simple tool in a clinical setting can provide a springboard for addressing difficulties with illness‐related couple communication and could aid decision making for referrals to couple counselling.     

A validation study of the Cardiac Depression Scale (CDS) in a UK population

Objectives: This study was designed to validate the Cardiac Depression Scale (CDS) in a UK cardiac population. Method: A battery of questionnaires (the Medical Outcomes Study Short‐Form 36 [SF‐36] Health Survey, the Beck Depression Inventory [BDI], the Hospital Anxiety and Depression Scale [HADS] and the Cardiac Depression Scale [CDS]) was mailed to 487 individuals with coronary heart disease (CHD) recruited from cardiac support groups. The process was repeated on a subsample of 80 participants four‐six weeks later for the purpose of test‐retest analysis. Results: The response rate from the first administration was 81% and from the test‐retest subsample 54%. Factor analysis revealed a one‐factor solution with a high internal reliability (Cronbach's α = 0.93) and an acceptable test‐retest reliability (0.79). Concurrent validation against the SF‐36, BDI and HADS demonstrated strong correlations. Conclusions: The CDS is both a reliable and sensitive instrument for measuring depression in cardiac patients.     

Development and preliminary validation of the Maternal Burnout Scale (MBS) in a French sample of mothers: bifactorial structure,reliability, and validity

Archives of Women's Mental Health - The study and evaluation of burnout in the context of parenthood have been of growing interest over the last years. The aim of this study is to develop and...